Symptoms of Lymphoma
The most common symptoms of lymphoma include painless enlarged lymph nodes (especially in the neck), fever, night sweats, unexplained weight loss, fatigue, pruritus (itching), and alcohol-induced pain. 1
Common Presenting Symptoms
Lymphadenopathy
- Painless enlarged lymph nodes are the most common presenting symptom, occurring in over 60% of patients with Hodgkin lymphoma (HL) 1
- Cervical lymph nodes are most frequently affected, especially in HL 1
- Lymph nodes are typically firm, non-tender, and may range from 2-10 cm in diameter 2
B Symptoms
- Fever (without identifiable infection) 1
- Drenching night sweats 1
- Unexplained weight loss >10% of body weight over 6 months 1
- These symptoms indicate more advanced disease and affect prognosis 1
Other Common Symptoms
- Fatigue 1
- Pruritus (itching) 1
- Alcohol-induced pain (pain in lymph node regions after consuming alcohol) 1
- Irritability (particularly in pediatric patients) 1
Symptoms by Lymphoma Type
Hodgkin Lymphoma
- Bimodal age distribution with peaks in young adults (20-40 years) and older adults (>55 years) 1
- Predominantly involves lymph nodes, with only 5% arising in extranodal sites 2
- Mediastinal involvement is common 2
Non-Hodgkin Lymphoma
- Approximately 30% present with extranodal involvement 2
- Symptoms vary based on subtype and location:
- Diffuse large B-cell lymphoma commonly affects paranasal sinuses, mandible, maxilla, and Waldeyer's ring 2
- Marginal-zone lymphoma has predilection for ocular adnexa, salivary glands, larynx, and thyroid 2
- Burkitt lymphoma more frequently affects maxilla and mandible, especially in children and young adults 2
Site-Specific Symptoms
Abdominal Involvement
Thoracic Involvement
- Coughing 1
- Dyspnea (shortness of breath) 1
- Wheezing or stridor 1
- Chest pain 1
- Reduced physical endurance 1
Head and Neck Involvement
- Swelling in neck, jaw, gingival area, or maxilla 1
- Difficulty swallowing 1
- Choking sensation 1
- Vision changes 1
CNS Involvement
Oncologic Emergencies
Lymphoma may present with acute complications requiring immediate intervention:
- Tumor lysis syndrome 1
- Superior vena cava syndrome 1
- Respiratory compromise 1
- Spinal cord compression 1
Clinical Pitfalls and Caveats
- Lymphoma symptoms can mimic many other conditions, leading to delayed diagnosis 3
- In immunocompromised patients (transplant recipients, HIV-positive), lymphoma risk is increased and may present with atypical features 3
- Extranodal lymphoma should be considered in the differential diagnosis of any lesion in the head and neck region, especially when typical risk factors for squamous cell carcinoma are absent 4
- Multiple, large, non-necrotic lymph nodes or multiple sites of extranodal disease should raise suspicion for lymphoma 4
- Patients on immunosuppressive therapy with Epstein-Barr virus (EBV) positivity require close monitoring due to increased lymphoma risk 3